Coeliac disease (2019)

Type of publication:
Journal article

Author(s):
*Butterworth J.; *Los L.

Citation:
Medicine (United Kingdom); 2019; vol. 47, no. 5, p. 314-319

Abstract:
Coeliac disease (CD) is a common, chronic, immune-mediated small bowel enteropathy resulting from gluten exposure in genetically susceptible individuals. Considerable clinical and immunopathological heterogeneity is seen in newly diagnosed patients, and the diagnosis is not always straightforward even for experienced physicians. Population screening using tissue transglutaminase 2 has revealed a higher prevalence of seropositivity than previously appreciated. There is a wide differential diagnosis for mucosal villous atrophy, crypt hyperplasia and increased intraepithelial lymphocyte concentrations. Life-long adherence to a gluten-free diet is currently the only recommended treatment for CD, although many newer approaches are being explored. CD is rightly described as a multisystem disorder and is associated with other gastrointestinal and non-gastrointestinal related disorders, numerous complications and possibly reduced survival. The landscape has recently expanded with the identification that some patients with symptoms suggestive of CD but without the mucosal changes seem to respond to a gluten-free diet. This group of patients are currently labelled as having non-coeliac gluten sensitivity. Controversy exists over whether this is a separate disease entity. This review briefly discusses the important clinical, immunological and therapeutic aspects of CD.

Two decades of coeliac disease in a district general hospital in England: What has changed? (2017)

Type of publication:
Conference abstract

Author(s):
*Singh R.; *Ayub N.

Citation:
Archives of Disease in Childhood; May 2017; vol. 102, Suppl. 1

Abstract:
Aim To determine the changes in clinical presentation of Coeliac Disease in children aged less than 16 years over a period of 20 years (January 1996 to December 2015) at a DGH in England Methods A retrospective case study of the clinical presentation of biopsy-proven Coeliac disease in children, at a DGH over a period of 20 years divided into four equal periods (1996-2000, 2001-2005, 2006-2010 and 2011-2015). Relevant information was extracted and input into an Excel database by a single researcher for further analysis. Results Coeliac Disease was diagnosed in 114 children over the study period. Twelve children were excluded from final analysis. These comprised of 05 children with insufficient information and 07 children with Insulin-Dependent Diabetes Mellitus( IDDM) diagnosed with Coeliac Disease as a result of their annual screening investigations. Twenty (20) new cases of Coeliac disease were identified during each of the study periods 1996-2000 and 2001-2005. This increased to 31 cases during the study periods of 2006-2010 and 2011-2015. Although 85% of cases were diagnosed under the age of 12 years, there was a trend towards diagnosis at an older age and increasing female representation. Anaemia (53%) and diarrhoea (49%) were the commonest and most consistent symptoms. Constipation (10%) occurred in a significant minority. However, recurrent abdominal pain (46%) was not only a major symptom after the age of 3 years but increasingly likely from 2006 onwards with 71% affected in 2011-2015. Abdominal distension (24%) remained relatively unchanged while faltering growth (27%) and small stature (8%) showed a decreasing trend. Vomiting (17%) was more likely in children under the age of 4 years. Conclusion Although Coeliac Disease is being diagnosed more frequently, there is a trend towards diagnosis at an older age with increasing female representation. Iron deficiency anaemia and diarrhoea have remained unchanged as the commonest symptoms but recurrent abdominal pain is a significant symptom, especially in the older child. Constipation is found in a significant minority but both faltering growth and small stature show a decreasing trend.

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Border-line coeliac serology in children – Outcome and correlation with histology (2017)

Type of publication:
Conference abstract

Author(s):
*Fox H.; Cheng J.H.; *Singh R.; *Ayub N.

Citation:
Journal of Pediatric Gastroenterology and Nutrition; Apr 2017; vol. 64 ; Supplement 1, p. 18

Abstract:
Objectives and study: Coeliac disease is an immune-mediated condition that affects the lining of the intestine when exposed to gluten. The British Society of Paediatric Gastroenterology, Hepatology and Nutrition guideline on Coeliac Disease (2013) recommends that patients with Tissue Transglutaminase antibodies (TTG) less than 10 times normal should undergo duodenal biopsy to confirm a diagnosis of Coeliac Disease. However, there is a paucity of data on how often this correlates with a final diagnosis of Coeliac disease. This study is to measure the sensitivity of borderline Tissue Transglutaminase Antibody (TTG) levels (greater than normal but less than 10 times of normal values) in diagnosing Coeliac disease. Methods: The Study Population was children aged 1-16 years with TTG levels less than 10 times of normal seen at The Shrewsbury & Telford Hospitals NHS Trust. The study period was from January 2010 to September 2016. Patients were identified from the biochemistry database. Relevant data including the clinical symptoms, TTG levels, IgA levels, HLA status and histology results were collected using the hospital data base. The histology results were classified according to the Modified Marsh Criteria. Results: A total of 52 patients had TTG levels between 2 – 19.9 U/ml which is less than ten times of the normal range used by our biochemistry laboratory. The median age of presentation was 10 years while the median TTG value was 4.2U/ml. 10 patients with Type 1 Diabetes Mellitus were detected to have border-line positive coeliac serology on routine testing. Thirty-nine patients underwent endoscopy with duodenal biopsies. Ten patients had neither endoscopy nor HLA testing performed because of various reasons including parental choice, symptom resolution prior to endoscopy while still on a normal diet, or repeat TTG levels within the normal range. 29 children (56%) out of the cohort of 52 had histological changes consistent with coeliac disease and were diagnosed as such. Seven of these (24%) had Grade 1 Marsh criteria, 3 children (10%) had Grade 2 Marsh criteria and 19 (66%) had Grade 3 Marsh criteria. There was no significant difference in symptomatology between the children who were diagnosed with coeliac disease and those with normal biopsies, apart from recurrent abdominal pain which was commoner in coeliac disease. Conclusion: 56% of children with borderline TTG levels were diagnosed with coeliac disease based on biopsy changes. Symptomatology was of poor discriminatory value apart from recurrent abdominal pain which was commoner in coeliac disease. Children with border-line positive coeliac serology should have duodenal biopsies to confirm a diagnosis of coeliac disease.

Link to more details or full-text: http://pdfs.journals.lww.com/jpgn/2017/04001/50th_ESPGHAN_Annual_Meeting_.1.pdf